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The 29th Annual Richard J. Smith Memorial Lectureship: April 27, 2018 and The 5th Annual Jesse B. Jupiter International Hand Forum: April 28, 2018.
Saturday, April 28, 2018 Ritsaart F. Westenberg, Research Fellow
What an exciting day! Not just because the nerves were topic of discussion, but because this year’s Jupiter Forum was dedicated to the wrist. No subjects were untouched. The nerves of the wrist, the carpals, the distal radius, and even Kienbock’s disease has been topic of discussion. One thing was concluded very quickly. If it is Kienbock’s disease, refer the patient to Dr. Mudgal!
It was a day with tough and enriching discussions between physicians from all over the world. It was the mentor versus the mentee, the millennials versus the baby boomers, and not every discussion ended in consensus. But Dr. Fischer saw what he hoped to see, the student aspiring to be a better doctor than his teacher. One thing was concluded by all: more research is needed!
The morning concluded with a beautiful review of the treatment of distal radius fractures through the years by Dr. Jesse Jupiter. We went as far back in history as the Ming Dynasty and no questions were left after this great talk.
Following lunch, everybody was charged to continue the discussion. We talked about scaphoid fractures and its blood supply. The scaphoid is like Bolivia (the land-locked country of South-America), covered by cartilage with only a small access for arteries to supply it blood. Several questions were raised. Is the vascularized bone graft a myth that needs to be busted by Adam Savage? How long do you cast a non-displaced scaphoid fracture? The preferred treatment options and answers varied not only amongst US physicians, but also between the internationals. These differences were not only seen for the scaphoid fractures, but also for carpal tunnel release after fracture of the wrist. The rate of carpal tunnel release after carpal and distal radius fractures clearly differed between the US and Europe. Regarding the scaphoid one thing was certain, some nonunions of the scaphoid are more equal than others.
Dr. Thomas J. Fischer was the cherry on top of the day with his talk about the forearm axis. It once again showed the close relation of the wrist and elbow and the ring concept…which is not referring to Dr. Ring. If there is ever going to be a journal of wrist and elbow, then we found our editor(s) today.
Hopefully we will see you all and other bright minds next year at the 6th Annual Jesse B. Jupiter International Hand Forum.
Friday, April 27, 2018 Ritsaart F. Westenberg, Research Fellow
With the impeccable view of the city skyline over one of America’s oldest cities, colleagues, orthopaedic residents, researchers, medical students, and friends met to learn, teach, and share their curiosity and knowledge in improving health care at the Wyndham Hotel Boston. It was a promising day with Dr. Duretti Fufa as Young Surgeons Forum Orator and Dr. Thomas J. Fisher as Smith Day Orator.
Dr. Mudgal kicked the day off with an introduction and kind words to the people who helped make all this possible. Most important was the rule of the day; each speaker had 5 minutes for their presentation. If you went over the allotted 5 minutes, you ran the risk of bodily harm by a taser from the visiting Orators!
We had the pleasure of listening to a large variety of upper extremity topics, starting with presentations about nerve injuries and reconstruction ranging from cadaveric studies to non-human primate models. The studies showed that there is larger difference between the nerves in the different flexor zones of the hand than one would expect, that there are still some challenges in the treatment of carpal tunnel syndrome, and that the future of nerve grafting with photochemical tissue bonding looks promising. We saw how feeding and wrapping techniques make it possible to perform a non-anesthetized MRI for babies with a brachial plexus injury. However, the question remained if this technique is applicable in the claustrophobic adult patients.
It was a morning with great discussions. A study of Dr. Langhammer about the characteristics of the acute limb-threatening upper extremity trauma raised the question of what would be the best approach in the treatment of mangled upper extremities. With the continuous development of advanced robotic prosthesis, early amputation and TMR might become the better option.
Lunch provided a nice chance to catch up with old colleagues and friends. After a wonderful meal and dessert it was time for the presentation by Dr. Fufa. She gave a thought-provoking talk about the utility of ultrasound in the counselling of patients with Soong grade 2 and FPL-irritation after volar plating of the distal radius.
After a few more presentations, including one showing the effect of being mindful on physical function scores, it was time to relax and bring the mindfulness into practice. A 60-second mindfulness based video exercise was presented and recently tested in orthopaedic patients showing that it can decrease pain and improve psychological outcomes. Since, everybody in the room still was a little bit anxious about getting tasered, we used this video to get back into our comfort zone for the last part of the day.
The day concluded with the awarding of two prizes for outstanding translational or clinical research. The Richard J. Smith Prize went this year to Jacob Silver and colleagues for their study on “Implementation of a Post-operative Opioid Prescribing Protocol Significantly Reduces Total Morphine Milligram Equivalents Prescribed”. The Jesse B. Jupiter Prize went this year to Marek Hansdorfer and colleagues for their study on “Large Gap Peripheral Nerve Repair in a Non-human Primate Model."
We finished off the meeting with Dr. Fisher’s presentation on why physicians teach. Physicians teach to give back by paying it forward. You train the doctor who is eventually going to take care of you and your children. Teach from generosity, do what you value, stay curious, and share your wisdom. Eventually the student becomes better than the teacher.
Thank you very much for your input and your attendance. We are looking forward to seeing you next year at the 30th annual Richard J. Smith Day.
Thomas J. Fischer, MD will present the 29th Annual Smith Day Oration.
All events will be held at the Wyndham Hotel on Blossom Street, Boston, MA.
Thomas J. Fischer, M.D., is a native Hoosier (graduated from Butler University), earned his medical degree from the Indiana University School of Medicine and completed his Orthopaedic training at the University of Washington in Seattle. After his hand fellowship at the Indiana Hand to Shoulder Center, he requested an additional six months of microvascular surgery training at Duke University, and six months of hand education at multiple centers in Switzerland and Germany before joining us in practice.
Dr. Fischer is an avid educator, with a primary focus on skeletal fixation. Residents from the Indiana University Department of Orthopaedic Surgery rotate with Dr. Fischer for their hand surgery exposure for the last 25 years. In addition, he is an active and highly visible part of our fellowship training program. He has been Chairman of various hand and wrist AO advanced courses both in North American and Europe.
In addition to publications in scientific journals and presentations before physicians, Dr. Fischer has been recognized for his written and spoken contributions to industry, insurance companies, and community and safety organizations alike.
Currently, Dr. Fischer is the Department Chairman of Hand Surgery at St. Vincent Hospital and Health Services. He is also a member of the Board of Trustees since 2004 at Butler University. He chairs the Academic Standard Committee for the University. Dr. Fischer serves on numerous committees such as: North American Hand Education Committee starting in February of 2008; American Orthopaedic faculty member starting in April of 1990; and Hand Expert Group starting in January of 2005. He is a member of AOA, TCOA, and The Hand Forum. He has served as the Butler Team Physician for upper extremity conditions since 1987.
Dr. Fischer and his wife, Maribeth have four children who are their pride and joy. He loves spending time with them watching Butler sports, camping, hiking, fishing, and his most favorite, bike riding. Along with those activities, Dr. Fischer is an avid photographer and part-time astronomer.
He sees patients in Indianapolis and keeps a satellite office in his hometown of Terre Haute, Indiana.
Richard J. Smith, MD was an extraordinary individual and one who could not be replaced. Henry Mankin, MD, in writing Richard Smith’s obituary in the Journal of Bone and Joint Surgery in 1987, stated so eloquently, “his capacities, talents, and commitment made him, in the eyes of man, our finest flower and the thirty years he gave to hand surgery, one of its finest periods.”
Dr. Smith was born in the Bronx, New York, attending the prestigious Bronx High School of Science. He received his college education at Brown University, graduating in 1951. His medical education was obtained at New York Medical College, where he was elected to AOA and graduated in 1955. Following a surgical internship at Bellevue Hospital, Dr. Smith began his Orthopaedic surgical training at the Hospital for Joint Diseases in New York City, completing the program in 1960. During his training at the Hospital for Joint Diseases, he became a disciple of Emmanuel Kaplan, MD, who at that time was a leading authority in anatomy of the hand. Under Dr. Kaplan’s tutelage, Dr. Smith became determined to pursue a career in the relatively new field of hand surgery.
Following a two-year obligation to the Public Health Service in Boston, Dr. Smith spent a year of Hand Fellowship, divided between Mr. Guy Pulvertaft in Derby, England and Dr. Joseph Boyes in Los Angeles, California. In 1963, Dr. Smith returned to the Hospital for Joint Diseases to join Dr. Kaplan and later in 1968 to succeed him as the Director of the Hand Service. During this time, he established himself as an outstanding clinician, surgeon, and most of all, a renowned educator.
In 1972, Dr. Smith moved to Boston to become the Chief of the Orthopaedic Hand Service at the Massachusetts General Hospital and, in 1980, was named Professor of Orthopaedic Surgery at Harvard Medical School. During his tenure at the MGH, he expanded his activities in hand surgery to an international level and in 1982 served as President of the American Society for Surgery of the Hand.
Dr. Smith always found the time to be a devoted husband to his wife Jane and a devoted father to his daughters Lisa and Tracey, and late son James.
For all who had the unique good fortune to have known Dr. Smith, studied under him, or worked with him in any capacity, what will endure most of all was his remarkable skill and devotion to education, the pursuit of excellence, and the advancement of the specialty of hand surgery.
In 1989, the MGH Orthopaedic Hand Service, led by Jesse B. Jupiter at that time, designated a day in honor of Dr. Smith and his life’s work. This year marks the 29th Annual Richard J. Smith Memorial Lecturership commonly known as “Smith Day” with Thomas J. Fischer, MD as the distinguished orator.
Thomas J. Fischer, MD will present the 5th Annual Jupiter International Forum Oration.
Course Description: This activity is targeted towards orthopaedic surgeons, plastic surgeons, and general surgeons with an interest in hand and upper extremity surgery. Experienced hand and upper extremity surgeons—particularly those that are involved in teaching, research, and writing—need a course that goes beyond didactics. Through an interactive setting where areas of debate and variation are addressed dynamically with the lines between faculty and participants being blurred, this course will provide experienced surgeons with a forum where they can get feedback on new ideas and find best practices or consensus directions for future research. Participants will benefit from immediate feedback on where concepts and practices fit within the best evidence and standard approaches. Using vignettes, cases, and debatable issues, moderators will play the role of provocateur, raising the breadth and depth of opinion for discussion, and reinforcing the scientific methods and systems approaches that can reduce unwarranted variation, and optimize care of hand and upper extremity illness, leading to improvements in leaner competence and performance.
Dr. Jesse Jupiter
Jesse B. Jupiter, MD, MA is Professor of Orthopaedic Surgery at MGH. He earned his MD at Yale in 1972 and completed his surgical internship at the University of Pennsylvania Hospital in 1973.
Following, Dr. Jupiter completed a two-year commitment as a general medical officer in the US Public Health Service Indian Health branch with the Pima Indians in Arizona. His interest in medical education was enhanced with the development of educational programs improving primary care for both diabetic and arthritic patients.
In 1975, he began the Harvard Combined Orthopaedic Residency Program. In 1980, Dr. Jupiter traveled to Basle, Switzerland where he completed an AO Fellowship after which he completed a hand and microvascular fellowship in Louisville, KY.
He returned to Boston in 1981 and began his academic and clinical career at MGH. During his 33 years on the faculty he has had the opportunity to head the Trauma Service, Foot and Ankle Program and the Hand Service.
Dr. Jupiter is an honorary member of more than 20 international societies of either Hand Surgery or Orthopaedic Surgery and has been named to America's Top Surgeons annually and Best of Boston since 2007.
Dr. Jupiter is an internationally known and sought after hand and upper limb specialist. He has given more than 1000 scientific presentations, published more than 220 original publications, 140 analytic reviews, 115 chapters in scientific texts and was co-author or co-editor of 10 major texts in upper limb and orthopaedic problems. Dr. Jupiter has developed a worldwide reputation, especially related to problems of the wrist and elbow along with all other conditions involving the hand and upper limb.
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